Apply the survivability model: Water rescue

Control Measure Knowledge

One of the most important decisions to be taken at water incidents is whether actions are being taken to rescue or recover casualties. A rescue is for when people display signs of life or are considered able to survive. Recovery is made when people are known to be deceased.

The distinction between rescue and recovery is important because it is a strong factor for decision-making. The level of acceptable risk for a rescue is considerably higher than that for body recovery in almost all circumstances.

Survivability model

A model has been developed to help incident commanders decide if a casualty is survivable. Joint decision-making may be required, with other emergency services or rescue organisations that are in attendance. Appropriate police and ambulance resources should be requested at the earliest opportunity.

The model is designed to give casualties every reasonable chance of rescue and resuscitation and is balanced against the risk of harm to personnel when carrying out rescues.

The main factors to be considered are the length of time the casualty has been submerged and the water temperature. Water temperature in the UK averages about 10°C but can range from 0°C to 25°C, depending on the location and type of water. Available medical evidence suggests that water temperatures in the region of 6°C to 7°C or less are required for prolonged survival times in submerged casualties, sometimes described as ‘icy cold’.

It is not possible to know for certain when a casualty became submerged, so the clock should start when the first emergency responder arrives on-scene. It should not be assumed that the casualty has been submerged for longer than this. However, if control room operators can gather credible information to identify an accurate time for when the casualty became submerged, the clock may be started at this point. Credible information sources that may be able to confirm this can be:

  • Visual awareness systems, such as 999eye
  • Closed-circuit television (CCTV) footage
  • Credible witnesses, such as other emergency service responders

This can provide the incident commander and other decision-makers with improved information and reduce the level of exposure to risk in response to the level of activity required.

It may be beneficial to align local control rooms in the use of information gathering and call scripting to improve the accuracy of information gathered. Joint decision-making will be supported if there is credibility in the information about the time the casualty became submerged.

The incident commander should carry out an appropriate risk assessment, balancing the likelihood of casualty survival against the likelihood and severity of harm to personnel.

It is anticipated that after 30 minutes all three emergency services will probably be on-scene. This may include specialist teams from the ambulance service and other rescue organisations. The incident commander should participate in joint decision-making with the other agencies, to determine the tactical plan and develop a joint understanding of risk.

The first element to consider is the likelihood of survival. This clinical decision will be taken by the ambulance service based on the criteria above, or in their absence, by the incident commander. If the water is icy cold the casualty should be considered survivable, although the likelihood of survival reduces as time passes. The risk assessment should be revisited to decide if a rescue should continue or if the incident should switch to body recovery.

If a decision is taken to continue the rescue then, at 60 minutes the incident commander should participate in further joint decision-making and risk assessment with the other agencies. If the water is cold and the casualty is known to be young or small, they should be considered survivable, although again their chances further reduce as time passes. The risk assessment should be revisited to decide if a rescue should continue or if the incident should switch to body recovery.

After 90 minutes, the incident commander should liaise again with the other agencies. A joint decision should be made to switch to body recovery, as the circumstances are regarded as no longer survivable.

Submerged casualties

If a casualty is or has been submerged, it may be necessary to apply the survivability model. For more information refer to Appropriately informed actions – Search and rescue of a submerged casualty.

Body recovery

Once the joint decision is made to commence body recovery, the police become responsible and should be requested, if not already in attendance. Fire and rescue services may become involved, depending on local arrangements, but personnel should not be put at undue risk to perform a body recovery.

Any incident where a body is discovered should be treated as a potential crime scene, and disturbance kept to a minimum. However, it may be necessary for personnel to secure the body to prevent it from being swept away.

For more information refer to:

Figure: Survivability in water model

Strategic Actions

Tactical Actions